Subspecialty Consultative Care Varies for Patients Enrolled in Medicare

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Researchers evaluated the use of subspecialty consultation for Medicare beneficiaries hospitalized for nonsurgical conditions, compared payments for consultative and nonconsultative care, and assessed payment differences across hospital referral regions.

In 2014, Medicare spent $1.3 billion on inpatient subspecialty consultative care. Limiting subspecialty consultative care may represent an area for cost savings for Medicare, according to study results published in JAMA Network Open.

Researchers of this retrospective, cross-sectional study assessed data from Medicare fee-for-service beneficiaries who were hospitalized for nonsurgical conditions to evaluate potential cost-saving areas between nonconsultative care and subspecialty consultative care. Data were retrieved from a random sample of 15% of beneficiaries enrolled in Medicare Part A and Part B, who were discharged after an acute care hospital stay, were assigned a general attending physician, and had a consultation by a subspecialist. Outcome measures included the probability of a consultation, the number of consultations per stay, and total Part B payments for consultative and nonconsultative care.

Of the 735,627 discharges included in this study, 58.8% of the patients were women, 84.7% were white, and the mean age was 79.6 ± 8.9 years. The median hospital stay with subspecialty consultative care was 5 days, and the median hospital stay without subspecialty consultative care was 4 days. Hospital stays with subspecialty consultative care more frequently took place in the Northeast, at larger hospitals, at teaching hospitals, and in urban settings (P <.001 for all). Overall, 31.7% of all discharges included 1 consultation, 13.5% of all discharges included 2 consultations, and 7.6% of all discharges included ≥3 consultations.

A substantial variation was found in payment per stay for subspecialty consultative care of Part B payments between hospitals at the highest quintile and the lowest quintile, with a relative difference of $401 (95% CI, $368-$434), and between hospital referral regions, with a relative difference of $363 (95% CI, $337-$389). In total, 41.3% of Medicare Part B payments were for subspecialty consultative care, which amounted to $1.3 billion in 2014.

Limitations of this study included the fact that it only accounts for direct payment to physicians and not downstream costs, does not measure the quality of care or specific medical outcomes, and does not allow attending physicians to submit >1 claim per day.

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The researchers concluded, “Whether patients have improved outcomes as a result of these consultations remains unclear, but the substantial variation in the use of subspecialty consultative care suggests potential opportunities for cost savings.”

Drs Ryskina and Werner reported multiple associations with health agencies. Please see the original reference for a full list of authors’ disclosures.

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Ryskina KL, Yuan Y, Werner RM. Association of Medicare spending with subspecialty consultation for elderly hospitalized adults. JAMA Netw Open. 2019;2(4):e191634.

This article originally appeared on Medical Bag